| NPI | 1245049659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL 13789) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 012432) |
| Enumeration Date | 2025-01-01 |
| Last Update Date | 2025-03-18 |